Nurses Should Play a Larger Role in Healthcare, IOM Says

WASHINGTON -- Expansion of nurses' scope of practice is just one of the ways to meet the growing demands for healthcare services created by the Affordable Care Act (ACA) that are detailed in a new report from the Institute of Medicine (IOM).

"Restrictions on scope of practice, policy- and reimbursement-related limitations, and professional tensions have undermined the nursing profession's ability to provide and improve both general and advanced care," according to the summary from "The Future of Nursing, Leading Change, Advancing Health."

The report, prepared by the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the IOM, has four key messages that "informed the recommendations" of a joint committee chaired by former Health and Human Services (HHS) Secretary Donna Shalala:

Nurses practice should reflect their educational level.

More nurses should pursue higher levels of education through an improved system.

Nurses should be "full partners" in the redesign of U.S. healthcare.

Better data collection and information infrastructure are needed for planning work force and policy changes.

The ACA calls for a number of healthcare improvements that nurses are well-equipped to handle, IOM President Harvey Fineberg wrote in the report, including in the areas of managment of chronic conditions, primary care, prevention and wellness, and prevention of hospital-acquired infections.

The report writers noted that, as the single largest segment of the healthcare work force, the nation's three million nurses "have the potential to effect wide-reaching changes in the healthcare system."

But that ability is hampered, the committee noted, because licensing regulations in most states limit the scope of practice of the more than a quarter of a million advanced practice nurses -- nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives.

Because of the "patchwork of state regulatory regimes," scope-of-practice issues should be addressed by the federal government, the report noted, "by collecting and disseminating best practices from across the country and incentivizing their adoption" through actions by the Federal Trade Commission and federal offices and agencies involved in purchasing health insurance, including Medicare and Medicaid.

"The Centers for Medicare and Medicaid Services has the responsibility to promulgate rules and policies that promote Medicare and Medicaid beneficiaries' access to appropriate care, and therefore can ensure that its rules and polices reflect the evolving practice abilities of licensed providers," the report summary reads.

The report also recommends better preparing nurses to handle more responsibility, setting as a target that 80% of nurses have a bachelor's degree by 2020 and doubling the number with doctorates.

"Transforming the nursing profession is a crucial element to achieving the nation's vision of an effective, affordable healthcare system that is accessible and responsive to all," said committee vice chair Linda Burnes Bolton, director of nursing research at Cedars-Sinai Medical Center in Los Angeles, in a statement.

Although acknowledging the shortage of healthcare providers, the AMA is not in favor of the expansion of nurses' scope of practice.

"Increasing the responsibility of nurses is not the answer to the physician shortage," Rebecca Patchin, MD, an AMA board member said in a statement. "Research shows that in states where nurses can practice independently, physicians and nurses continue to work in the same urban areas, so increasing the independent practice of nurses has not helped solve shortage issues in rural areas."

Patchin also contrasted the educational preparation of the two professions, noting that the "additional years of physician education and training are vital to optimal patient care, especially in the event of a complication or medical emergency."

The report and the Initiative on the Future of Nursing are sponsored by the Robert Wood Johnson Foundation.

MedPageToday is a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals.

Physicians and other healthcare professionals may also receive Continuing Medical Education (CME) and Continuing Education (CE) credits at no cost for participating in MedPage Today-hosted educational activities.